Prone breast biopsy table enables faster, more comfortable procedures

TORONTO – North York General Hospital, known as a technological innovator, has become the first hospital in Ontario (and the second across Canada, after the McGill University Health Centre) to implement a prone breast biopsy table that makes use of 3D mammography for needle guidance.

The new system provides better accuracy, shorter procedures and improved patient comfort in comparison with traditional breast biopsy systems, most of which are performed in the upright position.

The Affirm Prone Biopsy System was installed at the Toronto-based academic community hospital this March. (Hologic is the manufacturer of the system, and it’s sold and implemented in Canada by Christie Innomed.)

“We’re committed to innovative imaging with compassionate care,” said Mike Sharma, Director of Clinical Diagnostics at North York General. “That’s exactly what we’ve done with the new Affirm Prone biopsy table.”

The technology certainly enables more compassionate care, as in the prone position the breast is placed through an opening in the table and the needle-based procedure occurs out of the patient’s view, helping reduce anxiety. That’s unlike the upright procedures, where the patient directly observes the needle as the biopsy is performed.

Accuracy is also improved with the Affirm Prone Biopsy System. Using 3D imaging for biopsy guidance, the radiologist obtains a more accurate location of the lesion, including complex biopsies – whether it’s a faint calcification or a subtle distortion – in contrast with conventional 2D systems. This marks one of the most significant advances in biopsy technology since the first prone biopsy system was introduced more than 20 years ago.

Dr. Ryan Margau, Chief Radiologist at NYGH, commented: “Over the past few years, there has been a significant advance in breast imaging technology. Specifically, the principles involved in CT scanning are now being applied to mammography, so that radiologists can see three-dimensional mammographic images. This is called tomosynthesis or 3D mammography.”

Dr. Margau explained further that, “The technology will help radiologists to sample potential cancers in a more accurate way, and facilitate earlier detection of tumours, when they are easier to treat.”

“Another key benefit to this new tomosynthesis technology is that the images can be obtained without high radiation dose compared to older systems,” he added. That’s because it replaces the need for several 2D imaging exposures with a single 3D imaging exposure.

Overall, the procedure is faster, too, as a result of automation and better design. With older breast biopsy systems, the tube head of the imaging device had to be positioned manually. The new Affirm Prone Biopsy System does this automatically, which saves time.

The software streamlines workflow, as needle parameters are automatically calculated so the procedure goes faster and opportunities for error are greatly reduced.

Sharma noted that biopsies using the new system generally take about 10 minutes, compared with 20 minutes for older systems.

The rotating biopsy arm facilitates lateral access to the breast, if needed. This allows clinicians quick and easy access to hard-to-reach lesions and thinly compressed breasts, therefore reducing the number of patients that would otherwise be sent to the OR for a lumpectomy.

The system’s computer calculates the x, y coordinates for the lesion and automatically positions the needle. The doctor is responsible for placing the needle into the breast, so the doctor can control needle penetration according to the patient’s comfort level.

Already, in its first five months of use, there has been an overwhelmingly positive response from women to the table. Sharma noted that about three to five patients per day are being treated using the new table, a volume that’s sure to increase.

Most of them are telling their technologists that the procedure was less frightening than they expected, and that they’d recommend it to friends and family who need a breast biopsy. For its part, North York General has achieved the Breast Center of Excellence status for both imaging and surgeries. Every breast cancer patient’s case is reviewed by a multidisciplinary group of radiologists, surgeons, oncologists, pathologists, geneticists and nurses – an approach that’s unique in the Toronto area, and perhaps across Canada, too.